SurgeCon: An Emergency Department Surge Management Platform

NCT04789902 | Active Not Recruiting

• 2 other identifiers: 20201482SR4-165123
• Study Type: interventional
• Target: 436,052
• Locations: 1 country
• Sites: 4

Brief Summary

Wait times and overcrowding are challenging emergency departments (EDs) around the world. Several countries with advanced healthcare systems cannot keep pace with patient demand, and Canada ranks among the longest wait times compared to peer-industrialized countries. In fact, the Canadian Institute for Health Information (CIHI) identified an 11% increase in ED wait times from 2015-2016 to 2016-2017. This translates to long wait times that deter patients from pursuing necessary care and increases their likelihood of leaving without being seen by an ED physician. In Newfoundland and Labrador (NL), this issue has precipitated strikingly serious situations regarding long wait times that have made the province a case-in-point for ED issues. To counter this, the investigators propose an innovative quality-improvement intervention called SurgeCon that includes a protocol-driven software platform and several other initiatives to reduce wait times and improve the sustainability of health systems without significant workforce changes. The investigators piloted SurgeCon at the ED in Carbonear, Newfoundland and Labrador (NL) and found there was a 32% reduction in ED wait time.

Conditions

Length of Stay; Emergency Departments

Keywords

SurgeCon; Emergency Department; Stepped-Wedge Design; Randomized Trials; Wait Time

Outcome Measures

Primary Outcomes (3)

• Length of stay

  Key Performance Indicator (KPI) data at the time of the emergency department visit. Total length of stay in the emergency department. Patients are either admitted/transferred to an inpatient unit in the hospital or discharged from the emergency department.

  31 Months

• Time to physician's initial assessment

  Key Performance Indicator (KPI) data at the time of the ED visit. Also referred to as 'door to doctor' time. It is the amount of time it takes from patient arrival to being seen by a physician or their delegate.

  31 Months

• Number of patients left without being seen

  Key Performance Indicator (KPI) data at the time of the ED visit. Patients who are registered and/or triaged but leave before being seen by a physician or their delegate.

  31 Months

Secondary Outcomes (2)

• Patient satisfaction and patient reported experiences with ED wait time

  31 Months

• Economic impact of intervention on emergency department services

  31 Months

Study Arms (4)

Hospital site 1

EXPERIMENTAL

This site will provide usual ED care during the control period which will last for the first six months of the study. After six months this site will begin transitioning to the SurgeCon management platform which they will use until the end of the study.

Other: SurgeCon

Hospital site 2

EXPERIMENTAL

This site will provide usual ED care during the control period which will last for the first 12 months of the study. After 12 months this site will begin transitioning to the SurgeCon management platform which they will use until the end of the study.

Other: SurgeCon

Hospital site 3

EXPERIMENTAL

This site will provide usual ED care during the control period which will last for the first 18 months of the study. After 18 months this site will begin transitioning to the SurgeCon management platform which they will use until the end of the study.

Other: SurgeCon

Hospital site 4

EXPERIMENTAL

This site will provide usual ED care during the control period which will last for the first 24 months of the study. After 24 months this site will begin transitioning to the SurgeCon management platform which they will use until the end of the study.

Other: SurgeCon

Interventions

SurgeCon OTHER

The SurgeCon intervention is a pragmatic ED management platform that includes three distinct intervention components which include 1) Restructuring ED Organization \& Workflow, 2) Establishing a Patient-Centric ED Environment, and 3) E-Health Action-Based ED Management that together act to improve ED efficiency and patient satisfaction and value of care.

Hospital site 1; Hospital site 2; Hospital site 3; Hospital site 4

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• All individuals who visit any of the four selected emergency departments during the study period will be included.

You may not qualify if:

• none

Sponsors & Collaborators

• Memorial University of Newfoundland: lead
• Canadian Institutes of Health Research (CIHR): collaborator
• Government of Newfoundland and Labrador: collaborator
• Eastern Health: collaborator
• Trinity Conception Placentia Health Foundation: collaborator

Study Sites (4)

Burin Peninsula Healthcare Centre

Burin, Newfoundland and Labrador, A0E1E0, Canada

Location

Dr. G.B. Cross Memorial Hospital

Clarenville, Newfoundland and Labrador, A5A1K3, Canada

Location

Health Sciences Centre

St. John's, Newfoundland and Labrador, A1B 3V6, Canada

Location

St. Clare's Mercy Hospital

St. John's, Newfoundland and Labrador, A1C5B8, Canada

Location

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Related Links

• Canadian Institute for Health Information. Emergency department wait times in Canada continuing to rise
• BBC News. Dramatic rise in waiting times at emergency departments
• How long is too long to wait in an emergency room?
• The Commonwealth Fund. The commonwealth fund 2010 international health policy survey in eleven countries.
• CBC News. Labrador senior waits 10 hours in emergency room without care for broken arm.
• CBC News. Picture of senior waiting for hours in St. John's emergency room sparks outrage.
• CBC News. St. Anthony patients kept on stretchers while beds remained in storage.
• Canadian Institute for Health Information. PROMS background document.
• Canadian Institute for Health Information. Patient experience
• Lean Production. Kaizen

MeSH Terms

Conditions

Emergencies

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Shabnam Shabnam, PhD

  Memorial University of Newfoundland

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Model Details: This is a stepped-wedge cluster randomized trial (SW-CRT) design, where the sequential crossover will occur in one direction. SW-CRT is a flexible CRT design progressively being used in trial arms with varying delays in switching from the control condition to the active intervention condition state. This study will include the implementation of the intervention in four different rural and urban hospitals. Therefore, one hospital will be randomly allocated using a stratified sampling technique to each of four sequences, which will determine the order in which the intervention is implemented across participating hospitals or clusters. This allocation of one cluster to each sequence maximizes the statistical power

Study Record Dates

• First Submitted: March 3, 2021
• First Posted: March 10, 2021
• Study Start: January 1, 2021
• Primary Completion: August 31, 2024
• Study Completion: March 31, 2026
• Last Updated: October 1, 2025

Record last verified: 2025-09

Data Sharing

• IPD Sharing: Will not share

Locations

CA (4)